Vertebral triplaner alignment method

ABSTRACT

This invention is a vertebral triplaner alignment facilitator to enable a surgeon to make minute vertebrae adjustments during spinal surgery. The vertebral triplaner alignment facilitator includes a support device which is adapted to support a tensioning device. The support device includes a support structure and a gurney. The gurney is adapted to support the tensioning device, while the support structure supports the gurney above a patient. The support structure typically includes a support rod, a sacral bridge, and adjustment rods. The support rod may be adapted to connect to a retractor. The sacral bridge may be adapted to sit on the iliac spines or crests of the pelvis. The adjustment rods movably engage the support rod and the sacral bridge such that the adjustment rods can move laterally over the patient and longitudinally relative to the retractor. A plurality of gurneys engage the adjustment rods such that they may move along the adjustment rods and may pivot about the adjustment rods. Each gurney tracks and pivots independently of the other gurneys, as does each adjustment rod. Each gurney is adapted to support the tensioning device such that the tensioning device may pivot about an axis perpendicular to the gurney. Thus, the alignment facilitator allows the tensioning device to be moved through multiple translational and to rotational degrees of freedom.

This application is a divisional of U.S. application Ser. No.09/095,242, filed Jun. 9, 1998.

BACKGROUND OF THE INVENTION

There are five bones in the human skeleton called vertebral bodies thatcomprise the structure of the lumbar spine. These bones are normally ina structure which allows them to be stacked on top of one another muchlike building blocks. In this relationship, and through theirinterlocking structure, the spine can bend forward, called flexion, orbend backwards, called extension. It can bend to either side, calledlateral bending, and it can also twist or rotate. These ranges of motionare facilitated by muscles which attach to the lumbar vertebrae andthese motions are stabilized not only by the bones themselves but byligaments and discs which attach to these vertebrae.

In the course of human development, human deterioration and variousdisease processes and trauma, the alignment of the spine can be alteredin such a way that one or more bones might become loose on one anothercausing an instability problem. The medical term for this problem isspondylolisthesis. The vertebral bodies also might develop a curvatureproblem called scoliosis. The development of arthritic spurs may alsodistort spinal configuration. Fractures, tumors, infections, andextensive surgical procedures can also distort spinal anatomy and spinalintegrity resulting in the development of deformities of the lumbarspine.

In the last 30 years, a great deal of work has been done in orthopaedicson the development of procedures to stabilize deformity in the lumbarspine, and more recently to correct that deformity. The reason tocorrect the deformity is that the lumbar spine serves in many ways as afoundation on which the remaining structure of the thoracic and cervicalspine exists. Having the lumbar spine in a more appropriate positionallows for more normal functioning of the spinal structure above it.

Surgery is sometimes required to realign the spine. Generally, thesurgeon will cut into the back of the patient to access the spine. Hewill use a retractor to hold skin and muscle away from the spine toimprove his access to the spine. To align a lumbar vertebra, a screwcalled a pedicle screw will be inserted into the pedicle portion of alumbar vertebra. Then the surgeon will pull on the pedicle screw to movethe lumbar vertebra into appropriate alignment. Usually, internalhardware will then be attached to the spine to maintain properalignment. To avoid trauma to the muscles, ligaments and nerves attachedto the spinal cord, it is very important that the vertebra not be yankedinto alignment. However, accomplishing this objective is easier saidthan done. Occasionally, with the pressure that is required to “pull”the vertebra into alignment, when the resistance to realignment isovercome, the surgeon cannot react quickly enough to prevent thevertebra from being yanked. In fact, gradual, even pressure on thevertebra is difficult to accomplish, thus making the surgery one ofgreater risk to complication than is desirable.

What is needed is a device to allow the surgeon access the pedicle screwfrom various angles and a platform and device which will enable thesurgeon to apply even pressure on the vertebra as it is pulled intoalignment without “yanking” the vertebra into place.

The device should be one which can be manipulated through multipledegrees of freedom to align with the pedicle screw is needed.

The device must enable the surgeon to apply a steady, gently, increasingtension to the pedicle screw during the alignment process.

The device should allow the surgeon to concentrate on the delicacies ofthe procedure, rather than muscling a vertebra into position.

The device should allow the surgeon to make minute adjustments tovertebra during spinal surgery to reduce the risk of back surgery to apatient.

Such a device would preferably maintain spinal alignment while thesurgeon attaches in-dwelling hardware.

A device satisfying these needs is believed to be lacking in the priorart.

SUMMARY OF THE INVENTION

The invention relates to equipment used in conjunction with surgery andmore specifically to a device for use in conjunction with back, orspine, surgery. The device enables the surgeon to make minute vertebraladjustments. This invention is an alignment facilitator which aids theorthopedic surgeon in realigning the vertebrae of the spine; it enablesthe surgeon to make minute vertebral adjustments during the course ofspinal surgery and greatly reduces the risk associated with such aprocedure.

During a lumbar vertebrae alignment procedure, the surgeon will attach apedicle screw to the pedicle portion of lumbar vertebrae and gently pullvertebrae into alignment by applying tension to the pedicle screw. Thisinvention includes a tensioning device adapted to attach to the pediclescrew and apply tension to the pedicle screw. It also includes a supportdevice adapted to support the tensioning device over the patient. Thesupport system includes an alignment system so that the surgeon canalign the tensioning device with the pedicle screw. Alternatively, thesupport device may include a tracking and pivoting system which includesmeans for supporting and aligning the tensioning device.

The tracking and pivoting system will allow the surgeon to place thetensioning device in proper alignment with the pedicle screw. Thesupport device will generally include a forward support and a rearwardsupport for supporting the tracking and pivoting system.

The orientation and directions used in this application are relative toa patient lying face down. A forward location is closer to the head ofthe patient than a rearward location. Longitudinal and lateraldirections are along the body of the patient, and across the body (fromside to side), respectively. These directions and orientation wouldchange as appropriate when the invention is used in other orientations.Other positions and orientations would allow the invention to be used toalign other vertebrae or bones.

The rearward support, in one embodiment, includes a sacral bridge whichis adapted to sit on iliac spines, or iliac crests of the patient. Thisis because the hip bones generally provide a solid stable surface whichwould not be traumatized by the, albeit relatively minimum, weight orpressure produced when tension is applied to the pedicle screw. Theforward support, generally, includes a support rod. The support rodwould be adapted to fit on a stable and strong surface, such as aretractor, or the scapula portion of the back, or similar surface.

The support device includes an adjustment rod slidably connected to thesacral bridge and slidably connected to the support rod so that theadjustment rod can move laterally above the patient. The adjustment rodmay be movably connected to the support rod, so that the adjustment rodcan move longitudinally relative to the support rod. Alternatively, orin combination, the support rod may be movably connected to theretractor so that the adjustment rod can move relative to the retractor.

The support device also includes a gurney for supporting and aligningthe tensioning device. The gurney engages the adjustment rod so that thetensioning device may move longitudinally and may pivot about an axisparallel to the adjustment rod. In one embodiment, the gurney includesbearing connections at the forward and rearward supports so that theadjustment rod may pivot. Thus, the adjustment rod can move via thegurney, and the tensioning device may, but need not, be fixedly attachedto the adjustment rod. Alternatively, the gurney can move via theadjustment rod.

Alternatively, the gurney includes a longitudinal pivotal connectorengaging the adjustment rod so that the gurney may pivot or rotate aboutan axis parallel to the adjustment rod. In one embodiment the gurneypivots about the adjustment rod. In one embodiment, the tensioningdevice is movably attached to the gurney.

The gurney, in one embodiment, includes a slidable connector engagingthe adjustment rod so that the gurney may move longitudinally along theadjustment rod. The slidable connector engaging the adjustment rod, inone set of embodiments, includes grooves, or slots, adapted to mate withslots in the adjustment rod. The slots may, alternatively, be in theforward and rearward supports to allow movement of the adjustment rod.

In another embodiment the slidable connector includes one or more guiderollers. Each guide roller, generally, includes a central groove forengaging the adjustment rod so that the guide roller may rolllongitudinally along the adjustment rod and pivot about the adjustmentrod. The guide roller need not have a central groove, it may, forinstance, have a ball-bearing connector, or other connector, whichallows similar movement.

The gurney further, typically, includes a second pivotal connectoradapted to attach to the tensioning device so that the tensioning devicemay pivot about a second axis, where the second axis is transverse tothe adjustment rod. Typically, the second axis will be perpendicular tothe adjustment rod. The second axis may, however, be at some angle otherthen 90° relative to the adjustment rod. The tensioning device, however,must be sufficiently supported to allow tension to be applied to apedicle screw.

In one embodiment, the gurney (or gurney assembly) typically includesguide rollers and a side plate. The side plate maintains the guiderollers in a fixed spatial relation relative to each other, and theguide rollers have a central groove.

The gurney assembly also typically includes a bracket pivotallyconnected to the side plate. The bracket is adapted to attach to thetensioning device so that the tensioning device may pivot about an axisperpendicular to the side plate.

In one embodiment, the bracket includes a first arm pivotally connectedto the side plate and a second arm adapted to attach to the tensioningdevice so that the tensioning device may pivot by the axis perpendicularto the side plate. Since the axis perpendicular to the side plate istypically also perpendicular to the adjustment rod, the tensioningdevice will pivot about an axis perpendicular to the adjustment rod.

The gurney assembly, thus, provides the surgeon two translationaldegrees of freedom and two rotational degrees of freedom to align thetensioning device. In this embodiment, one translational degree offreedom is lateral translation through movement of the adjustment rod.The second translational degree of freedom is longitudinal throughmovement of the adjustment rod relative to the retractor, and movementof the gurney relative to the adjustment rod. The first rotationaldegree of freedom corresponds to rotation of the gurney about theadjustment rod. The second rotational degree of freedom corresponds torotation of the bracket relative to the side plate of the gurney, i.e.,about an axis perpendicular to the adjustment rod. It will be apparentto add hinged or pivotally connected members between the tensioningdevice and the gurney if one desires more flexibility or additionaldegrees of freedom.

The tensioning device is used in conjunction with the facilitator; itincludes a means to attach the tensioning device to the pedicle screwand a means to apply tension to the pedicle screw. In one embodiment,the tensioning device includes a threaded connector having a threadedend and an attachment end; the attachment end is adapted to attach tothe pedicle screw. The tensioning device also includes a collar and atensioning knob. The collar receives the threaded end of the threadedconnector and is disposed between the attachment end and the threadedend. The tensioning knob is threadably attached to the threaded end.Turning the tensioning knob draws the pedicle screw toward thetensioning device. Thus, small adjustments to the vertebrae areobtainable. Alternative conventional means for applying tension (orcompression) will be apparent.

Although this invention is discussed with reference to a pedicle screwand lumbar vertebrae alignment, it will be apparent that the tensioningdevice may be adapted to attach to any alignment screw. For example, itmay be adapted to attach to a vertebral laminar hook or an articularprocess screw, and the like. Similarly, the alignment facilitator may beused to facilitate alignment of cervical and thoracic vertebrae. It willalso be apparent that the alignment facilitator may be used to align anytwo bones, or two pieces of a bone, with respect to each other. In thatinstance, rather than the tensioning device being adapted to attach to apedicle screw, the tensioning device would be adapted to attach towhatever bone, or section of bone, is being aligned. The tensioningdevice may be attached to the bone or section of bone through use ofscrews, such as the pedicle screw, or through other conventional means.Thus, the alignment facilitator may be used to align fractured bones,out-of-joint knees, dislocated shoulders and rib, and the like. Ingeneral, the alignment facilitator may be adapted to aid an orthopedicsurgeon apply smooth, steady tension to realign any two bones orvertebrae with respect to each other.

As such, this device has been developed to assist in the surgicaltreatment of correcting deformities of the lumbar spine though it isadaptable to other treatments. This correction process is generallyaimed at dealing with the relationship of one or more vertebral bodiesrelative to one another:—in anterior/posterior translation (meaningfront to back), side to side translation, axial compression ordistraction (meaning top to bottom), and rotation.

Use of the triplaner vertebral alignment facilitator may includeattaching the facilitator to the Coker Spinal Retractor, or similardevice, on its more cephalad (toward the chest) use and attaching to abridge between the two iliac crests on its more caudad (toward thepelvis) use. The invention, thus, floats on either side of the spine ona quarter inch rod. By means of the tracking and pivoting system, thedevice is attached to each of the involved vertebral bodies by a screwplaced in the vertebral body's pedicle. The device can be fitted with anumber of different connecting devices which makes it universallyapplicable to all pedicle screws produced in the U.S. and internationalmarkets. By tightening the tension on the attachment to the vertebralpedicle screw, this device facilitates the correction of the previouslymentioned deformity (or deformities). Once the deformity is corrected,the device can be removed from one side of the spine and permanentspinal instrumentation can be installed and locked into place withappropriate locking devices. The alignment device is then removed fromthe opposite side of the spine and similar completion of the procedureis carried out on that side by application of the permanentinstrumentation devices. The alignment device is then replaced by apermanently in-dwelling fixation system which connects two or morevertebral bodies in appropriate spinal alignment. This allows for afusion between these bones to grow and thus maintain proper alignment ofthe bones.

An objective of this invention is to provide a surgeon with a device tomake minute adjustments of the spine during spinal surgery, thusreducing the risk of trauma to the patient and speeding the patient'srecovery. Another objective of the invention is to provide the surgeonwith multiple angles from which to attach alignment screws; thusallowing the surgeon to optimally align the tensioning device with thealignment screw and the direction of alignment. This reducesoff-alignment stress on the bone and improves the likelihood ofachieving a proper bone alignment.

The added dexterous control the surgeon receives by using the alignmentfacilitator, rather than other cumbersome methods, will allow thesurgeon to concentrate on the delicacies involved in the treatment,rather than on manhandling the vertebrae into alignment. Yet anotherobjective of the invention is to provide the surgeon with a device tomaintain proper alignment while permanent in-dwelling hardware isattached to the patient's bones. A further objective of the invention isto provide alternate means of aligning bones in addition to lumbarvertebrae.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a pedicle screw being used to align vertebrae within thelumbar section of the spine.

FIG. 2 is a perspective view of a vertebral triplaner alignmentfacilitator adapted for use with a retractor.

FIG. 3 shows a section view of the tensioning device shown in FIG. 2.

FIG. 4 is a perspective view of a vertebral triplaner alignmentfacilitator, similar to the one shown in FIG. 2, in use with aretractor.

FIG. 5 shows a plan view of a vertebral triplaner alignment facilitatorin use with a retractor.

FIG. 6 shows a side view of a gurney assembly.

FIG. 7 shows a side view of a gurney assembly showing the guide rollersbehind the side plate.

FIG. 8 is a top view of the gurney assembly.

FIG. 9 is an end view of the gurney assembly.

FIG. 10 shows a vertebral triplaner alignment facilitator with oneadjustment rod and an alternate gurney from the one shown in FIG. 2.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

FIG. 1 shows a partial side view of a spine. A pedicle screw S isinserted into one of the lumbar vertebrae. The spine is realigned bypulling on the pedicle screw S. Typically, a surgeon will enter apatient's back to perform an alignment procedure. The surgeon will use aretractor to keep skin and muscle away from the spine to improve hisaccess to the spine. The surgeon will need to get at the vertebrae fromnumerous angles. A screw is inserted into an appropriate portion of thevertebrae—typically a pedicle screw into the pedicle portion of thevertebra. The surgeon then applies tension to the pedicle screw S topull the vertebra into proper alignment.

FIG. 2 shows a triplaner vertebral alignment facilitator 10 adapted tobe used with and supported by a retractor. FIG. 4 shows an alignmentfacilitator 10, substantially similar to the one shown in FIG. 2,engaging a retractor R. The retractor R is used to hold the skin andmuscle away from the spine so that the surgeon can align the vertebraeby applying tension to the pedicle screw S inserted in the vertebrae.The details of construction of retractor R are shown in U.S. Pat. No.5,363,841, Retractor For Spinal Surgery, issued Nov. 15, 1994, byInventor Wesley L. Coker, which is incorporated herein by reference.

The triplaner vertebral alignment facilitator 10 shown in FIG. 2includes a tensioning device 20 and a support device, or support means,generally denoted as 40, for supporting the tensioning device 20. Thesupport device 40 includes an alignment means generally denoted as 46.The alignment means 46 may also be referred to as a tracking andpivoting system, or an alignment system. The alignment system 46 alignsthe tensioning device 20 with the screw S. The alignment system 46generally includes all the movable connections which allow thetensioning device 20 to pivot, rotate, and translate relative to apatient P. The movable connections will be described more fully withlater discussion.

The support device 40 also includes a rearward support 60, and a forwardsupport 70. The rearward support 60 and forward support 70 (alsoreferred to as a support system, or support structure) support thealignment system 46. In the embodiment shown in FIG. 2, the rearwardsupport 60 includes a sacral bridge 64; and the forward support 70includes a support rod 74. The sacral bridge is adapted to set on iliacspines of the patient P. The support rod 74 shown in FIG. 2 is adaptedto connect to the retractor R.

In the embodiment shown in FIG. 2, support rollers are attached tosupport rod 74 to rollably engage the retractor R. The support rollersinclude a first support roller 76 and a second support roller 78. Anadjustment rod 80 movably engages the support rod 74 and the sacralbridge 64 so that the adjustment rod 80 can move laterally over thepatient P. Adjustment rod 80 includes a first alignment roller 92 and asecond alignment roller 94. The first alignment roller 92 rollablyengages the sacral bridge 64, and the second alignment roller 94slidably and rollably connects the adjustment rod 80 to the support rod74 so that the adjustment rod 80 may slide in a first direction and rolland a second direction relative to the support rod 74. In the embodimentshown in FIG. 2, the first direction is longitudinal, and the seconddirection is lateral.

The triplaner alignment facilitator 10 shown in FIG. 2 includes a secondadjustment rod 84 also movably engaging the support rod 74 and thesacral bridge 64 such that the second adjustment rod 84 can also movelaterally over the patient P. The second adjustment rod 84 is similarlyconnected via its set of alignment rollers—first alignment roller 96 andsecond alignment roller 98. It will be apparent that a “rolling” or a“sliding” motion is not critical. The connection need not be “rollable”or “slidable,” any anti-friction connection, or other movableconnection, e.g. ratcheting, would suffice.

The vertebral triplaner alignment facilitator 10 shown in FIG. 2, alsoincludes a plurality of gurneys (gurney assemblies) 100 adapted tosupport the tensioning device 20. Typically, each gurney 100 issubstantially similar to the others. As such, only one gurney 100 willbe described. The gurney 100 includes a plurality of guide rollers 112engaging the adjustment rod 80. A side plate 120 maintains the guiderollers 112 in a fixed relation relative to each other such that thegurney 100 may roll longitudinally along the adjustment rod 80 and pivotabout a first axis running through the adjustment rod 80.

FIG. 3 more clearly shows the guide roller 112 on the adjustment rod 80.Also shown in FIGS. 2 and 3 is a bracket 130 pivotally attached to thegurney 100. The bracket 130 includes a first arm 134, or a first end134, pivotally attached to the side plate 120, and second arm 136, oranother end 136. The second arm 136 is adapted to support the tensioningdevice 20 such that the tensioning device 20 may pivot about a secondaxis, where the second axis is perpendicular to the side plate 120.FIGS. 8 and 9 also show a bracket substantially similar to the one shownin FIGS. 2 and 3.

It will be apparent that the second axis which the tensioning device 20pivots about need not be perpendicular to the side plate 120 and theadjustment rod 80. The second axis may be transverse to the adjustmentrod (or the first axis), where transverse is defined as other thanparallel. The first axis, which the tensioning device 20 typicallypivots about, is generally parallel to the adjustment rod, but, it neednot run through the adjustment rod 80. Further, the side plate 120 maybe other than flat and need not be in plane with the adjustment rod 80.The gurney 100 may pivot about the one axis independent of pivotingabout the other axis.

FIGS. 6 through 9 show a gurney 250 substantially similar to the gurney100 shown in FIG. 2. The gurney 250 includes a side plate 252maintaining the guide rollers 112 in a fixed relation, i.e. fixedrelative to each other. Typically, the gurney 250 would include a secondopposing side plate 253. FIG. 8 shows the second opposing side plate 253attached to the guide rollers 112 on and the side plate 252 with pins.The guide rollers 112 are maintained between the two opposing sideplates 252 and 253. The gurney 250 shown in FIG. 7 includes three guiderollers 112; at least two guide rollers 112 that are opposing. Theopposing guide rollers engage the adjustment rod 80 and trap it betweenat least two guide rollers 112. The gurney 250 may move longitudinallyrelative to the adjustment rod 80 and pivot about the adjustment rod 80.

It will be apparent that the tensioning device 20 may be fixablyconnected to the adjustment rod 80 and the adjustment rod 80 movablyconnected to the forward and rearward supports.

FIG. 10 shows another embodiment of an alignment facilitator 200. Thealignment facilitator 200 shown includes an adjustment rod 210 movablyengaging a forward support 224, and a rearward support 226. Theadjustment rod 210 engages the rearward support 226, and the forwardsupport 224, through a first alignment roller 220, and a secondalignment roller 226, respectively. The first and second alignmentrollers 220 and 226 include roller bearings 222 and 228 to allowlongitudinal movement of the adjustment rod 210 relative to the supports224 and 226. The side plate 230 is fixedly attached to the adjustmentrod 210. And the tensioning device 240 is pivotally attached to the sideplate 230. The adjustment rod 210 and the alignment roller 220 and 226may also be referred to as a gurney since they provide a moveablesupport for the tensioning device.

The assemblage shown in FIG. 10 provides support similar to the gurney100 and adjustment rod 80 shown in FIG. 2. Both embodiments providesupport while allowing pivoting of the tensioning device about an axisthrough to the adjustment rod, lateral movement of the adjustment rod,and longitudinal movement of the adjustment rod.

The single adjustment rod model may be used where multiple adjustmentrods are not required. One or more tensioning devices may be supportedon the adjustment rod. And the connections shown in FIG. 10 may be usedwith multiple adjustment rods and gurneys.

Referring back to FIG. 2, the guide rollers 112 shown include a centralgroove 114. The central groove 114 engages the adjustment rod 80 suchthat the gurney 100 may pivot about and roll along the adjustment rod80. Gurneys, typically similar to gurney 100 previously described, alsoengage the second adjustment rod 84 as well as the first adjustment rod80.

Sacral supports 66 are shown attached to the sacral bridge 60 in FIG. 2.It will be apparent that the sacral bridge 60 and the sacral supports 66(as well as other supports) may be made adjustable to fit patientshaving different physical dimensions and limitations. Or the supportsmay be available in predetermined “sizes” to fit different patients. Thesacral bridge 60 may also be a universal support structure adapted tosupport the alignment facilitator 10 over other portions of the patientP. Similarly, the forward support 70 need not be adapted to connect to aretractor R. It may be adapted to attach to or rest on other portions ofa patient P, or rest on other devices used during the procedure. (SeeFIG. 10.) The supports may be removably attachable supports and adaptedto attach to particular locations on a patient or to meet needs of aparticular patient.

FIG. 3 shows a sectional view of the tensioning device shown in FIG. 2cut along section line A—A. FIG. 3 shows the adjustment rod 80, from anend view, supporting the guide roller 112. The side plate 120 is shownattached to the guide roller 112 and shown supporting the bracket 130.The bracket 130 shown includes a first arm 134 pivotally connected tothe side plate 120 and a second arm 136. The second arm 136 supports thetensioning device 20.

The tensioning device 20 shown in FIG. 3 includes a threaded connector22, a collar 26, and a tensioning knob 28. The threaded connector 22shown includes an attachment end 24 and a threaded end 23. The collar 26is disposed between the attachment end 24 and the threaded end 23. Thetensioning knob 28 is threadably attached to the threaded end 23.Turning the tensioning knob 28 applies tension to the pedicle screw Sand pulls the vertebrae into alignment.

FIG. 5 shows a plan view of a vertebral triplaner alignment facilitator10 substantially similar to the one shown in FIG. 2. It is shown adaptedfor use with a retractor R. The retractor R is also shown. FIG. 6 showsa side view of a gurney assembly 250. FIG. 7 shows a side view of agurney assembly 250; the side plate 252 has been removed to show theguide rollers 112. FIG. 8 is a top view of the gurney assembly 250. FIG.9 is an end view of the gurney assembly 250. Side plate 252 and secondopposing side plate 253 are shown in FIGS. 8 and 9 maintaining guiderollers 112 in a fixed relative position.

The guide rollers, alignment rollers, and other connections may be“loose” to provide free movement. Alternatively, they may be “tight” toprovide restrained movement. Preferably, the connectors are in between“loose” and “tight” to provide firm connections which may be easilyadjusted, but will prevent unintended slippage. Preferably, the gurney“floats” on adjustment rods 80 or 84 for ease of positioning. However,the guide rollers in one embodiment include a releasable ratchetmechanism to lock the guide roller down as the tensioning devicedistracts the bone.

In a preferred embodiment, similar to those shown in FIGS. 2 and 4, thevertebral triplaner alignment facilitator 10 includes a support device40, the support device 40 adapted to support a tensioning device 20. Thesupport device 40 includes a rearward support 60 and a forward support70, and a gurney 100. The gurney 100 is adapted to support thetensioning device 20; and the forward and rearward supports 70 and 60support an adjustment rod 80. The adjustment rod 80 supports the gurney100 above a patient P, or relative to a patient. The forward support 70includes a support rod 74. The rearward support 60 includes a sacralbridge 64. The support rod 74 is adapted to connect to a retractor R,and the sacral bridge 64 is adapted to sit on the iliac spines or crestsof a patent P. The adjustment rod 80 movably engages the support rod 74and the sacral bridge 64 such that the adjustment rod can move laterallyover the patient P.

The vertebral triplaner facilitator 10 includes a second adjustment rod84 similarly engaging the support rod 74 and the sacral bridge 64. Theadjustment rods' engagement will be described for one adjustment rod,since, typically, the connections for the adjustment rods are similar.The adjustment rod 80 includes a first alignment roller 92 and a secondalignment roller 94. The first alignment roller 92 rollably engages thesacral bridge 64. The second alignment roller 94 slidably and rollablyconnects the adjustment rod to the support rod 74 so that the adjustmentrod 80 may move in a first direction (laterally) and may move in asecond direction (longitudinally) relative to the support rod 74. Thesecond adjustment rod 84 is similarly connected through a firstalignment roller 96 and a second alignment roller 98.

A plurality of gurneys 100 engage the adjustment rods (80 and 84). Eachgurney 100 tracks and pivots independently of the other gurneys.Likewise, each adjustment rod (80 or 84) moves independently of theother adjustment rod (84 or 80).

The gurney 100 will be described with respect to the adjustment rod onwhich it sits, or engages. The gurney 100 includes a plurality of guiderollers 112 engaging the adjustment rod 80, the plurality of guiderollers 112 including at least two opposing guide rollers such that theadjustment rod 80 is between the two opposing guide rollers 112. Theopposing guide rollers 112 trap the adjustment rod 80 there between suchthat the gurney 100 may roll along, and pivot about, the adjustment rod80.

Each guide roller 112 includes a central groove 114. The central grooveengages the adjustment rod 80 such that the gurney 100 may rolllongitudinally along the adjustment rod 80 and pivot about theadjustment rod 80. The gurney 100 also includes a side plate 120. Theside plate 120 maintains the guide rollers 112 in a fixed relationrelative to each other.

The gurney 100 includes a bracket 130. The bracket 130 includes a firstarm 134 and a second arm 136. The first arm 134 is pivotally attached tothe side plate 120 and the second arm 136 is adapted to support thetensioning device 20 such that the tensioning device 20 may pivot aboutan axis perpendicular to the side plate 120.

Thus, although there have been described particular embodiments of thepresent invention of a new and useful “Vertebral Triplaner AlignmentFacilitator”, it is not intended that such references be construed aslimitations upon the scope of this invention except as set forth in thefollowing claims. Further, although there have been described certaindimensions used in the preferred embodiment, it is not intended thatsuch dimensions be construed as limitations upon the scope of thisinvention except as set forth in the following claims.

What is claimed is:
 1. A vertebral triplanar alignment method comprising the steps of: applying tension to a bone connection device using a tensioning device; aligning the tensioning device with the bone connection device using a vertebral alignment facilitator, where using the vertebral alignment facilitator includes supporting the tensioning device on a gurney; and supporting the gurney relative to a patient.
 2. The method of claim 1, wherein the supporting the gurney step further comprises the step of supporting the gurney on an adjustment rod.
 3. The method of claim 2, wherein the aligning step further comprises the step of pivoting the gurney about the adjustment rod.
 4. The method of claim 2, wherein the aligning step further comprises the step of pivoting the tensioning device about an axis transverse to the adjustment rod.
 5. The method of claim 2, wherein the aligning step further comprises the step of moving the gurney longitudinally relative the adjustment rod.
 6. The method of claim 2 further comprising the step of maintaining spinal alignment with the vertebral alignment facilitator while attaching in-dwelling hardware.
 7. The method of claim 2, wherein the aligning step further comprises the steps of adjusting the adjustment rod laterally, and pivoting the adjustment rod about an axis parallel to the adjustment rod.
 8. The method of claim 2, wherein the aligning step further comprises the step of adjusting the adjustment rod relative to the patient.
 9. The method of claim 8, wherein the adjusting the adjustment rod step further comprises the step of moving the adjustment rod laterally.
 10. The method of claim 1 comprising the step of maintaining spinal alignment with the vertebral alignment facilitator while attaching in-dwelling hardware. 